SMART on FHIR and the Personal Health Record

The PHR is the holy grail of health IT. Whereas the EHR belongs to the doctor, the PHR – the Personal Health Record – belongs to the patient. The PHR combines your own data and data from your healthcare providers into one single overview, which you can share with physicians of your choice.

In May, during eHealth Week in Amsterdam, the Dutch patient federation NPCF (with support of the government) launched a project to create a PHR specification framework. This is a set of requirements any Dutch PHR will have to comply to. These include an infrastructural specification, judicial and financial arrangements, and the format of the data that is being shared.

Another important part of the specification is the way third party apps can access (read or write) data from a PHR. Based on one national open API, third party apps will integrate with any PHR without having to conform to a proprietary API each time they want to integrate with a new system.

One challenge here is how to give which app access to which part of the data? And what rights do they get? This is the same problem that EHR’s currently face. They want to open up their system, but only to trusted apps, and only those pieces of data that a particular app or person has the rights and needs for. In the US, major EHR vendors conform to the guidelines of SMART on FHIR for this purpose. Last Friday David Hay posted a blog about SMART on FHIR. In a nutshell: SMART on FHIR is a generic, standardized solution for apps running in an EHR. Any EHR.

To make it easy for developers to get started building apps based on the SMART standards, open source libraries are available that simplify and streamline the use of these standards in real world apps. Currently, libraries are available for HTML5/JavaScript, iOS and Python. This would be great for PHRs as well, since they face these exact same issues, and will now have a great way to safely open up their data to third party applications.

If you want to know more about SMART on FHIR, visit FHIR Developer Days 2016 in Amsterdam from 16-18 November. DevDays will host a specific SMART on FHIR track that focuses on app integration with the EHR according to the SMART on FHIR concept. Josh Mandel from Harvard Medical School / Boston Children’s Hospital (the inventor of SMART on FHIR) will explain the principles of SMART on FHIR and guide a hacking session. Two separate hacking sessions within this track will focus on app integration in the Epic and Cerner EHRs. These will be guided by interop experts from Epic and Cerner.